Mind matters

Published : Feb 27, 2004 00:00 IST

A symposium on neuropsychiatry organised in Chennai brings together the best minds in the field to discuss and exchange perspectives on the renaissance that this field of medicine has witnessed over the past few decades.

in Chennai

ALTHOUGH the interface between neurology and psychiatry goes back to the 17th century, neuropsychiatry developed as an independent discipline only over the past three and a half decades. From the end of the 19th century to the first half of the 20th century, the orientation of this discipline became psychodynamic and human behaviour began to be explained only by psychological factors. The two fields drifted apart. But since the 1970s, advances made in areas such as neuroimaging, genetics and molecular biology have led to the growing recognition of brain pathology as the basis for psychiatric illnesses.

Today, neuropsychiatry has emerged as an important field of study. Various aspects of the renaissance were deliberated upon at the first International Neuropsychiatry Association India Symposium organised by the K. Gopalakrishna Department of Neurology, VHS Medical Centre, Chennai, in January. Internationally reputed neuropsychiatrists shared their experiences and dealt with areas such as epilepsy, movement disorders, dementia, schizophrenia and neurogenetics.

"Fundamental to any definition of neuropsychiatry is the inseparability of the mind and the body," said Chennai-based behavioural neurologist Dr. E.S. Krishnamoorthy, vice-chairman and consultant in clinical and behavioural neurology at the T.S. Srinivasan Institute of Neurological Sciences and Research, Public Health Centre, and chief of neuroepidemiology and consultant in clinical and behavioural neurology at the K. Gopalakrishna Department of Neurology, Voluntary Health Service (VHS) Medical Centre. Neuropsychiatry is a term that applies to a number of closely related fields because the interface between neurology and psychiatry is very broad. It draws on the perspectives of neurologists (who look at the brain as having an impact on human behaviour), biological psychiatrists (who study different parts of the brain that get affected by varying human behaviour), neuro-psychologists (who look at psychological functions as a product of brain functioning and development) and neuro-psychiatrists. All these areas and the correlations among them constitute the interface between the mind and the brain.

When we talk of the mind, the tendency is to touch the heart. Actually, there is no physical entity called `the mind'. It is the chemical, hormonal and neural links within the brain and the manner in which they express themselves that constitute the mind. The understanding of the mind came from focal brain problems and their expression in human behaviour. For example, Parkinson's is a disease of the basal ganglia and persons affected by it exhibit certain common behavioural changes - they tend to be more depressed or apathetic and tend to have more obsessive neurotic personalities that predate the disease. Similarly, people with temporal lobe epilepsy demonstrate behavioural characteristics such as an increased tendency to write copiously and keep diaries and an increased interest in religion. Depending on which parts of the frontal lobes are involved, various behavioural constellations - being apathetic and withdrawn, manic, disinhibited and aggressive - are observed.

Over the past three decades, there has been a surge in neuropsychiatry research. Studies show that the human brain is an incredibly plastic organ, much more than neuroscientists imagined. For example, a two-year study involving London's taxi drivers showed that the volume of hippocampus, a part of the brain involved in memory, changes as they memorise the London map.

Delivering the 18th K. Gopalakrishna Endowment lecture, Prof. Moises Gaviria of the University of Chicago explained the plasticity of the brain, when he spoke about "Mind, Brain and Music".

Path-breaking findings have been made in areas such as anxiety disorder and depression, where certain brain structures appear to be more involved than others. In the elderly, for example, interesting associations have emerged between cerebrovascular disease (stroke) and depression. According to Prof. Anthony S. David of the Institute of Psychiatry, King's College, London, it is becoming clear from research in magnetic resonance imaging (MRI) that significant changes occur in the brain of patients with schizophrenia and manic-depressive illness (bipolar disorder).

Several speakers at the symposium pointed to the significant advances that have been made in clinical research. Emerging evidence seems to suggest that psychological morbidity strongly predicts the outcome in terms of brain diseases. The behavioural pattern of patients with epilepsy, Parkinson's disease and dementia seems to play a significant role in the extent of their disability and their ability to recover. According to Prof. Perminder Sachdev of the University of New South Wales, motor function has a close association with thinking and emotion. Many psychiatric disorders, such as melancholic depression and schizophrenia, are characterised by prominent movement disturbances. The major `neurologic' movement disorders such as Huntington's, Parkinson's and Wilson's are commonly associated with psychiatric syndromes, and diseases such as Tourette's are mainly treated by psychiatrists although they are movement abnormalities.

Prof. Constantin Slodatos of the University of Athens, Greece, spoke on the neuropsychiatric aspects of sleep disturbances. According to him, sleep disorders such as fatal familial insomnia and narcolepsy are often associated with neuropathological alterations that accompany neuropsychological manifestations, and neurodevelopmental aberrations are found in people who sleepwalk or have nightmares.

According to Dr. Krishnamoorthy, unique environmental episodes early in life (even at the time of conception or birth) may be the cause for the onset of mental illnesses later on. Further, changes in the brain have been observed quite early in life and these may have a genetic basis. These findings regarding brain changes in people with mental illness put a whole new perspective on the approach to these problems and are helpful in eliminating the stigma these illnesses are unfortunately associated with.

Increasingly, there is the realisation that the brain does not function in parts but works more as a sum of parts. There is a great degree of connectivity in the brain. It is not just focal areas that govern certain behaviours, as previously believed, but entire connections, or what are called neural networks.

Certain behaviours are governed by specific parts of the brain. Many of these observations traditionally come from looking at focal problems in the brain. For instance, before scanning techniques emerged, autopsy was done on people who suffered from similar problems and then conclusions were drawn about which part of the brain was affected. Imaging has changed the perception relating to the study of the interface. While certain areas maybe predominantly responsible for specific functions, it might involve several areas of the brain.

While the biological link between the brain and human behaviour is exciting, behaviour is undoubtedly a product of psychological experiences and the environment. From a developing country perspective, it is important to understand how the psychological condition is going to influence the level of disability of a person with neurological illnesses. In India, there is very little recognition of the brain-psychology interface. It is not considered a public health issue.

According to Dr. Krishnamoorthy, India can contribute greatly in the field of clinical research. There are a number of illnesses, such as infections, which are over-represented in India and "we still do not know too well the consequences of brain infections," he said. Stressing the need to reach out to the masses, he said: "We have only 500 neurologists and 2,000 psychiatrists for a country as large as India. Most of them are concentrated in cities." He suggested measures such as training primary-care physicians, developing a system of community-based care, or having specialised nurses who can tackle some of these problems. At the moment none of these support systems exists and there is little initiative to create them.

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